FireEMT2009 Posted July 12, 2011 Posted July 12, 2011 You are dispatched to a call for a pt found unconscious on their floor. No further is given. You arrive to find a male patient 35y/o laying prone on a hardwood floor. Neighbor states that they were taking out the trash when they heard a loud thud from inside the house. You see broken glass all around the patient. The time is 2200 Go!! FireEMT2009
Chief1C Posted July 12, 2011 Posted July 12, 2011 Neighbor is lying, they obviously knocked the patient out with something glass, robbed them; then called 911 to make it look like an accident. I'd assess and likely immobilize, since he can't say "X Hurts", and consider distance to the nearest hospital... and which is the quickest way to get there.
FireEMT2009 Posted July 12, 2011 Author Posted July 12, 2011 Neighbor is lying, they obviously knocked the patient out with something glass, robbed them; then called 911 to make it look like an accident. I'd assess and likely immobilize, since he can't say "X Hurts", and consider distance to the nearest hospital... and which is the quickest way to get there. I would try to get more information before jumping on the neighbors a theif train, just saying.
Kiwiology Posted July 12, 2011 Posted July 12, 2011 Any signs of trauma? Usual alphabet soup dine in please we are in no hurry - BP, PR, RR, SPO2, ECG, BGL, temp, lung sounds Secondary survey - pupils, broken bones, abdo exam
Bieber Posted July 12, 2011 Posted July 12, 2011 (edited) Let's have somebody take C-spine and we'll role him onto his back after clearing any glass out of the way and make sure his airway's open. From there, why don't we... Assess his LOC. Assess his respirations (lung sounds, rate, depth). Assess his perfusion status (radial pulse, rate and quality; skin condition). Then let's have somebody get a set of vital signs (HR, BP, SpO2, BGL), I'll go ahead and do a quick head to toe. What do we have in terms of injuries? Also, guys, please be careful of the glass if you're gonna be kneeling down! Edited July 12, 2011 by Bieber
FireEMT2009 Posted July 12, 2011 Author Posted July 12, 2011 Any signs of trauma? Usual alphabet soup dine in please we are in no hurry - BP, PR, RR, SPO2, ECG, BGL, temp, lung sounds Secondary survey - pupils, broken bones, abdo exam The patient was found unconscious after the neighbor heard a thud when taking out the trash and he has glass around him, thats all the information you have about trauma due to the scene. Let's have somebody take C-spine and we'll role him onto his back after clearing any glass out of the way and make sure his airway's open. From there, why don't we... Assess his LOC. Assess his respirations (lung sounds, rate, depth). Assess his perfusion status (radial pulse, rate and quality; skin condition). Then let's have somebody get a set of vital signs (HR, BP, SpO2, BGL), I'll go ahead and do a quick head to toe. What do we have in terms of injuries? Also, guys, please be careful of the glass if you're gonna be kneeling down! Good Job Beiber, You clear the glass, C-Spine is taken, and airway is open. LOC: Unconscious Respirations: 24 Regular, normal depth, Lung sounds Wheezing. No Radial Pulse, Carotid is at 46, regular, weak, pale cool diaphoretic. HR: 46 Regular weak BP 68/32 SpO2: 97 BGL: 127 Temperature: 98.5 degrees F. Pupils: Constricted, Eyes are watery. Physical Exam: Tiny cuts are found in the skin, all bleeds are just oozing. Head: Unremarkable. Neck: No step-offs. Unremarkable. Chest- Unremarkable Abdomen: Soft, non-tender, unremarkable Pelvis: stable, unremarkable Legs: Unremarkable. You note a large amount of saliva on the ground at the patient's mouth. You also note the following things during the assessments: A strong smell of feces, diaphoresis, smell of urine, breath smells of vomit. What else do ya'll want? FireEMT2009
Bieber Posted July 12, 2011 Posted July 12, 2011 (edited) Good Job Beiber, You clear the glass, C-Spine is taken, and airway is open. LOC: Unconscious Respirations: 24 Regular, normal depth, Lung sounds Wheezing. No Radial Pulse, Carotid is at 46, regular, weak, pale cool diaphoretic. HR: 46 Regular weak BP 68/32 SpO2: 97 BGL: 127 Temperature: 98.5 degrees F. Pupils: Constricted, Eyes are watery. Physical Exam: Tiny cuts are found in the skin, all bleeds are just oozing. Head: Unremarkable. Neck: No step-offs. Unremarkable. Chest- Unremarkable Abdomen: Soft, non-tender, unremarkable Pelvis: stable, unremarkable Legs: Unremarkable. You note a large amount of saliva on the ground at the patient's mouth. You also note the following things during the assessments: A strong smell of feces, diaphoresis, smell of urine, breath smells of vomit. What else do ya'll want? FireEMT2009 Oh jeez, you really want to make me work, don't you? All right, well, I don't want to move him into the back of the truck just yet. Let's get some masks and gowns on everyone and consider this a possibly contaminated patient. What do we see around the house? What kind of area are we in, anyway? Farming land, maybe? Send somebody out to look around the outside of the house (along with the garage and shed if there is one) for any pesticides or the like. Let's strip him down and bag his clothes, and rinse his skin off with copious amounts of sterile water! After we rinse him off and dry him off, let's also put him on the monitor, get a quick 12-lead to make sure there's nothing going on in there, and if there isn't, let's go ahead and get a line on scene and pop 0.5 mg of atropine. While we're doing that, can we have somebody inspect the inside of his mouth, suction out any secretions, and maybe even start assisting ventilations to try and slow his respirations down with a BVM at 15 lpm and administer a dose of albuterol as well. Now let's reassess our interventions! And maybe think about getting headed toward the truck once we have the patient thoroughly deconned. Right now I'm strongly suspicious for organophosphate poisoning or some type of cholinergic poisoning. Oh hey! That reminds me. Mr. Neighbor, does the owner of this house keep any pesticides or the like around? Edited July 12, 2011 by Bieber 2
BushyFromOz Posted July 12, 2011 Posted July 12, 2011 (edited) Right now I'm strongly suspicious for organophosphate poisoning or some type of cholinergic poisoning. Oh hey! That reminds me. Mr. Neighbor, does the owner of this house keep any pesticides or the like around? Yeah im with you there mate, and awesome call on the PPE. Edited July 12, 2011 by BushyFromOz
FireEMT2009 Posted July 12, 2011 Author Posted July 12, 2011 Oh jeez, you really want to make me work, don't you? All right, well, I don't want to move him into the back of the truck just yet. Let's get some masks and gowns on everyone and consider this a possibly contaminated patient. What do we see around the house? What kind of area are we in, anyway? Farming land, maybe? Send somebody out to look around the outside of the house (along with the garage and shed if there is one) for any pesticides or the like. Let's strip him down and bag his clothes, and rinse his skin off with copious amounts of sterile water! After we rinse him off and dry him off, let's also put him on the monitor, get a quick 12-lead to make sure there's nothing going on in there, and if there isn't, let's go ahead and get a line on scene and pop 0.5 mg of atropine. While we're doing that, can we have somebody inspect the inside of his mouth, suction out any secretions, and maybe even start assisting ventilations to try and slow his respirations down with a BVM at 15 lpm and administer a dose of albuterol as well. Now let's reassess our interventions! And maybe think about getting headed toward the truck once we have the patient thoroughly deconned. Right now I'm strongly suspicious for organophosphate poisoning or some type of cholinergic poisoning. Oh hey! That reminds me. Mr. Neighbor, does the owner of this house keep any pesticides or the like around? Beiber, Luckly for you this patient is in pajamas, but decontamination should still be taken, the patient is deconned. He is in a suburban area, no farm land, plants or anything around the house is growing, neighbor says he works all the time. She says he works at a company that makes pesticides in small amounts but he doesn't know if it is in that department. You suction his mouth deliever the atropine. 12 lead only shows sinus bradycardia. Respirations are slowed and albuterol decreases wheezing but some is stll heard. His vitals are as follows: HR -58 RR-12 BVM SpO2- 98 BP 68/32 He is still has salivation and you have to continuously suction, The diaphoresis and lacrimation is still going on strong as well. What next for this patient?
Bieber Posted July 12, 2011 Posted July 12, 2011 Beiber, Luckly for you this patient is in pajamas, but decontamination should still be taken, the patient is deconned. He is in a suburban area, no farm land, plants or anything around the house is growing, neighbor says he works all the time. She says he works at a company that makes pesticides in small amounts but he doesn't know if it is in that department. You suction his mouth deliever the atropine. 12 lead only shows sinus bradycardia. Respirations are slowed and albuterol decreases wheezing but some is stll heard. His vitals are as follows: HR -58 RR-12 BVM SpO2- 98 BP 68/32 He is still has salivation and you have to continuously suction, The diaphoresis and lacrimation is still going on strong as well. What next for this patient? Oh jeez, I suddenly realized my mistake. Sorry, guys, I haven't reviewed this stuff in a while--what was I thinking? Let me go ahead and get my head out of my ass for a second and then we'll go ahead and give this guy a man size dose of atropine. Let's go with 2 mg and keep suctioning those secretions, we can give another albuterol as well.
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